CNS lesions with mass effect Venous volume Arterial volume Clinical manifestations CSF Brain Mass can present with headache, nausea vomiting, contusion, and lethargy, papilledema, all of which may reflect evidence of increased intracranial pressure Can cause neurologic focal impairment such as vision osS,weakness,sensory loss, aphasia, etc. Norma Compensated Decompensated normal Icp increased ICp
CNS lesions with mass effect • Clinical Manifesta2ons • can present with headache, nausea, vomiFng, confusion, and lethargy, papilledema, all of which may reflect evidence of increased intracranial pressure. • Can cause neurologic focal impairment, such as vision loss, weakness, sensory loss, aphasia, etc
Differential diagnosis of a brain mass Primary brain tumors Vascular disease Glioma Cerebral hemorrhage Meningioma Cerebral infarct Pituitary adenoma Vascular malformation Vestibular schwannoma Inflammatory Primary central nervous system Multiple sclerosis lymphoma Other Post-infectious encephalomyelitis Infections Granulomatous disease Abscess(bacterial, fungal, parasitic Vasculitis infection Textiloma Tuberculomas Metastatic brain tumors
Differen'al diagnosis of a brain mass Primary brain tumors Vascular disease Glioma Cerebral hemorrhage Meningioma Cerebral infarct Pituitary adenoma Vascular malformaFon VesFbular schwannoma Inflammatory Primary central nervous system lymphoma MulFple sclerosis Other Post-infecFous encephalomyeliFs InfecFons Granulomatous disease Abscess (bacterial, fungal, parasiFc) VasculiFs Viral infecFon TexFloma Tuberculomas MetastaFc brain tumors
Case 1 A 45 year-old female farmer presented with progressive weakness of left limbs and headache for more than a month she had no fever and received mannitol for controlling icp since the onset of the disease. physical examination showed a little nuchal rigidity and decreased muscle force of left limbs. Left Babinski sign presented
Case 1 • A 45 year-old female farmer presented with progressive weakness of leR limbs and headache for more than a month. She had no fever and received mannitol for controlling ICP since the onset of the disease. Physical examinaFon showed a liSle nuchal rigidity and decreased muscle force of leR limbs. LeR Babinski sign presented
Case 1 MRI ( Dec 15, 2015: Multiple space-occupying lesions in right frontal lobe and right thalamus region. T-spot(Dec 17, 2015 :+ Cryptococcus antigen(Dec 17, 2015) Lumber puncture(dec 17, 2015) Glucose 3.97mmol/ml, protein 875mg/LT, cells 106/L
Case 1 • MRI (Dec 15, 2015): MulFple space-occupying lesions in right frontal lobe and right thalamus region. • T-spot (Dec 17, 2015): + • Cryptococcus anFgen (Dec 17, 2015): - • Lumber puncture(Dec 17, 2015): • Glucose 3.97mmol/ml, protein 875mg/L ↑, cells 10^6/L
Differential diagnosis of a brain mass Primary brain tumors Vascular disease Glioma Cerebral hemorrhage Meningioma Cerebral infarct Pituitary adenoma Vascular malformation Vestibular schwannoma Inflammatory Primary central nervous system Multiple sclerosis lymphoma Other Post-infectious encephalomyelitis Infections Granulomatous disease Abscess(bacterial, fungal, parasitic Vasculitis infection Textiloma Tuberculomas Metastatic brain tumors
Differen'al diagnosis of a brain mass Primary brain tumors Vascular disease Glioma Cerebral hemorrhage Meningioma Cerebral infarct Pituitary adenoma Vascular malformaFon VesFbular schwannoma Inflammatory Primary central nervous system lymphoma MulFple sclerosis Other Post-infecFous encephalomyeliFs InfecFons Granulomatous disease Abscess (bacterial, fungal, parasiFc) VasculiFs Viral infecFon TexFloma Tuberculomas MetastaFc brain tumors